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Abdo Flashcards

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1
Q

Signs of chronic liver disease - general inspection (4)

A

Cachexia
Icterus
Excoriation
Bruising

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2
Q

Signs of chronic liver disease - hands (4)

A

Leuconychia
Clubbing
Dupuytrens contractures
Palmar erythema

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3
Q

Signs of chronic liver disease - face (3)

A

Xanthelasma
Parotid swelling
Fetor hepaticus

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4
Q

Signs of chronic liver disease - chest and abdo (5)

A

Spider naevi
Caput Medusa
Reduced body hair
Gynaecomastia
Testicular atrophy

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5
Q

Evidence of decompensation in liver patient (3)

A

Ascites - shifting dullness
Asterixis
Encephalopathy

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6
Q

Causes of hepatomegaly (6)

A

Cirrhosis (alcoholic)
Carcinoma (secondaries)
Congestive cardiac failure
Infectious - HBV/HCV
Immune - PBC/PSC/autoimmune hepatitis
Infiltrative - amyloid/myeloproliferative disorders

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7
Q

NILS screen (7)

A

Autoantibodies/immunoglobulins - AMA, ASMA, anti LKM, ANA, ANCA
Hep B/C serology
Ferritin
Caeruloplasmin
Alpha 1 antitrypsin
AFP
EBV/CMV

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8
Q

Complications of cirrhosis (8)

A

Variceal haemorrhage
portal HTN
Hepatic encephalopathy
SBP
Ascites
HCC
Hepatorenal syndrome
Clotting disorders

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9
Q

Causes of Ascites (3)

A

Cirrhosis
Carcinomatosis
CCF

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10
Q

Causes of palmar erythema (5)

A

Cirrhosis
Hyperthyroidism
RA
Pregnancy
Polycythaemia

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11
Q

Causes of gynaecomastia (6)

A

Physiological - puberty /senility
Kleinfelters syndrome
Cirrhosis
Drugs - sprionolactone/digoxin
Testicular tumour/orchidectomy
Endocrinopathy - hyper/hypothyroidism/ addisons

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12
Q

Signs of haemochromatosis (7)

A

Increased skin pigmentation
Stigmata of chronic liver disease
Hepatomegaly
Venesection
Liver biopsy
Joint replacement
Abdominal rooftop incision

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13
Q

Evidence of complications of haemochromatosis (4)

A

Bronze diabetes - Injection sites
Hypogonadism
CCF
Arthropathy - pseudogout

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14
Q

Autoantibody for PBC

A

AMA

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15
Q

Autoantibody for autoimmune hepatitis

A

ASMA

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16
Q

Inheritance of haemochromatosis

A

Autosomal recessive
Chromosome 6
HFE gene mutation - regulates gut iron absorption
Carrier rate 1:10
Males affected earlier - no periods

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17
Q

Investigation of haemochromatosis and results (8)

A

Raised ferritin
Raised transferrin saturation
Reduced total iron binding capacity
Liver biopsy
Genotyping
Blood sugars (diabetes)
ECG/CXR/echo (CCF)
Liver USS /AFP (HCC)

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18
Q

Treatment of haemochromatosis (4)

A

Regular venesection (1 unit per week until deficient, then 1 unit 3-4 times/year)
Avoid alcohol
Surveillance for HCC
Liver transplant - 50% 1 year survival, high mortality due to cardiac and infectious complications

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19
Q

Family screening for haemochromatosis (3)

A

Iron studies
Liver biopsy
Genotype analysis

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20
Q

Examination findings associated with splenomegaly (8)

A

Anaemia
Lymphadenopathy
Purpura
LUQ mass - moves inferomedially, has notch, dull to percussion, cannot get above
Hepatomegaly
Stigmata of chronic liver disease
Splinter haemorrhages/murmurs
Rheumatoid hands - felty syndrome

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21
Q

Causes of massive splenomegaly >8cm (4)

A

Myeloproliferative disorders - CML and myelofibrosis
Tropical infections - malaria, visceral leishmaniasis/kala-azar

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22
Q

Causes of moderate splenomegaly 4-8cm (4)

A

Myeloproliferative disorders
Lymphoproliferative disorders
Infiltration - gauchers and amyloidosis

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23
Q

Causes of a palpable spleen tip (4)

A

Myelo/lymphoproliferative disorders
Portal HTN
Infections - EBV, endocarditis, infective hepatitis
Haemolytic anaemia

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24
Q

Investigations for splenomegaly (7)

A

USS abdo
FBC and blood film
CT chest and abdo
Bone marrow aspirate and trephine
Lymph node biopsy
Thick and thin films (malaria)
Viral serology

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25
Indications for splenectomy (3)
Rupture - trauma Haematological - ITP and hereditary spherocytosis
26
Splenectomy work up (3)
Vaccination - pneumococcus, meningococcus and haemophilus influenza 2 weeks prior Prophylactic penicillin Medic alert bracelet
27
Clinical signs of renal failure - peripheral (4)
HTN AV fistulae Tunnelled dialysis line Immunosuppressant stigmata - cushingoid, gum hypertrophy ciclosporin
28
Clinical signs renal failure - abdominal (7)
Palpable kidney Iliac fossa scar +/- transplanted kidney Urine dip - proteinuria/haematuria External genitalia - varicocele Hepatomegaly (PKD) Indwelling catheter - obstructive uropathy Peritoneal dialysis scars/catheter
29
Causes of unilateral renal enlargement (4)
PKD Renal cell carcinoma Simple cysts Hydronephrosis
30
Causes of bilateral renal enlargement (4)
PKD Bilateral renal cell carcinoma (rare) Bilateral hydronephrosis Tuberous sclerosis - renal angiomyolipomata and cysts
31
Derm signs of tuberous sclerosis (4)
Shagreen patches Ash leaf spots Facial angiofibromas Ungual fibromas
32
Investigations for renal failure (6)
U&Es Urine cytology USS KUB IV urogram CT Genetic studies - ADPKD
33
What is autosomal dominant polycystic kidney disease? Which genes are involved?
Progressive replacement of normal kidney tissue by cysts leading to renal enlargement and renal failure Prevalence 1:1000 ADPKD1 85% chromosome 15/16 ADPKD2 15% chromosome 4 End stage renal failure by age 40-60 Earlier in ADPKD1
34
What are typical presenting symptoms of ADPKD? (4)
HTN Recurrent UTIs Abdominal pain - bleeding into cyst/cyst infection Haematuria
35
Other organs involved in ADPKD (3)
Hepatic cysts and hepatomegaly Intracranial berry aneurysms Mitral valve prolapse
36
Treatment of ADPKD (4)
Treat HTN Nephrectomy for bleeds/infection/size Dialysis Renal transplant
37
Signs of liver transplant (5)
Rooftop or Mercedes Benz scar Stigmata of chronic liver disease Skin pigmentation - haemochromatosis Tattoos/needle marks - infective Stigmata of immunosuppressive medications
38
Signs of immunosuppressive medications (5)
Ciclosporin - gum hypertrophy and HTN Steroids - cushingoid appearance, thin skin, ecchymoses
39
Top 3 reasons for liver transplant
Cirrhosis Acute hepatic failure - hep A/B and paracetamol overdose Hepatic malignancy
40
Success of liver transplant
80% 1 year survival 70% 5 year survival
41
Causes of gum hypertrophy - drugs (3)
Ciclosporin Phenytoin Nifedipine
42
Causes of gum hypertrophy (5)
Drugs Scurvy Acute myelomonocytic leukaemia Pregnancy Familial
43
Skin signs in transplant patients (6)
Actinic keratosis Squamous cell carcinoma (100x risk) Basal cell carcinoma (10x risk) Malignant melanoma (10x risk) Viral warts Cellulitis
44
Peripheral stigmata of renal disease (4)
AV fistula - thrill/dressings Tunnelled dialysis line Scars in neck/chest wall Leg oedema
45
What scars might you see on the abdomen of a renal patient? (3)
Iliac fossa scar from transplant Flank scar from nephrectomy Peritoneal dialysis scars
46
What signs might help decide cause of kidney disease? (7)
Enlarged kidneys - ADPKD Visual impairment/finger prick marks/injection sites - diabetes Sclerodactyly, typical facies - systemic sclerosis Rheumatoid hands/nodules - RA Hepatosplenomegaly - amyloid Other organ transplantation - calcineurin inhibitor nephrotoxicity Ungual fibromata, adenoma sebaceum, polycystic kidneys - tuberous serosis
47
What side effects of treatment might be visible in renal transplant patients? (6)
Fine tremor - tacrolimus Cushingoid appearance - steroids Gum hypertrophy- ciclosporin HTN - ciclosporin/tacrolimus Skin damage/malignancy - ciclosporin/azathioprine Scars from dialysis access/transplants
48
What will you find with a kidney-pancreas transplant on examination?
Lower midline abdominal incision Palpable kidney in iliac fossa but no overlying scar Evidence of previous diabetes eg visual impairment Often younger patients
49
Top 3 causes for renal transplant
Glomerulonephritis Diabetic nephropathy ADPKD
50
What are some complications of renal transplant? (8)
Rejection Infection secondary to immunosuppression - pneumocystis/CMV Skin malignancy Post transplant lymphoproliferative disease HTN and hyperlipidaemia causing CV disease Immunosuppressant drug side effects Recurrence of original disease Chronic graft dysfunction
51
What is the success rate of renal transplant?
90% 1 year graft survival 50% 10 year graft survival - better with live related donor grafts
52
Causes of clubbing - GI (5)
IBD Malabsorption Coeliac disease Liver cirrhosis Oesophageal cancer
53
What are examination findings in PBC? (6)
Hepatomegaly Hyperpigmentation Splenomegaly in latter stages Jaundice Xanthelasma Cirrhosis features
54
What are treatments for PBC? (5)
Ursodeoxycholic acid Sedating anti histamines colestyramine Steroids and azathioprine if overlap with autoimmune hepatitis Transplant
55
How can causes of jaundice be divided? (3)
Pre hepatic: haemolysis Intra hepatic: liver disease Post hepatic: biliary obstruction
56
What are signs and features of portal hypertension? (5)
Varices Splenomegaly Caput medusae Ascites Gastropathy
57
What scoring system can be used to risk stratify patients for liver transplant?
UK model for end stage liver disease
58
What are causes of Gynaecomastia? (7)
Physiological: puberty CLD Medications: spironolactone, digoxin Primary hypogonadism: 5alpha reductase, androgen insensitivity Tumours producing bHCG Secondary hypogonadism: kallmans, orchidectomy Hyperthyroidism
59
What is a common complication of TIPS?
Encephalopathy
60
What scoring system is used for decompensated liver disease? And what are the criteria? (6)
Child Pugh Bilirubin Albumin INR Encephalopathy Ascites

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